Autologous Bone Marrow Grafting Combined with Demineralized Bone Matrix Improves Consolidation of Docking Site After Distraction Osteogenesis
BACKGROUND:Distraction osteogenesis is used for the reconstruction of extensive osseous defects. Delay in docking site consolidation results in significant prolongation of this surgical procedure. The primary aim of the present study was to retrospectively compare three different treatment options,...
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| Veröffentlicht in: | Journal of bone and joint surgery. American volume 2011-04, Vol.93 (7), p.671-678 |
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| creator | Hatzokos, Ippokratis Stavridis, Stavros I Iosifidou, Eirini Karataglis, Dimitrios Christodoulou, Anastasios |
| description | BACKGROUND:Distraction osteogenesis is used for the reconstruction of extensive osseous defects. Delay in docking site consolidation results in significant prolongation of this surgical procedure. The primary aim of the present study was to retrospectively compare three different treatment options, all aimed at improving and accelerating docking site consolidation. We further sought to clarify whether the application of autologous bone marrow cells combined with demineralized bone matrix would substantially improve docking site consolidation.
METHODS:Between 1995 and 2008, forty-three patients (mean age, 38.28 years) were managed with bone transport for the treatment of a tibial bone defect (mean length, 9.49 cm). The patients were divided into three groups according to the “docking site procedure” usedclosed compression (Group A), surgical debridement of the docking site and application of autologous iliac bone graft (Group B), or surgical debridement and local application of bone marrow concentrate and demineralized bone matrix (Group C). Docking site consolidation was assessed both radiographically and clinically, and the results were statistically analyzed.
RESULTS:The median “healing time” required for docking site consolidation was significantly longer in the compression group as compared with the demineralized bone matrix plus bone marrow group (p = 0.021), whereas there was no difference between the other groups. There was no significant difference among the groups in terms of complication rates (p = 0.702). Docking site consolidation was completed prior to regenerate consolidation in nine of the ten patients in Group C and in 13.6% of the patients in Group B, whereas in all of the remaining patients, completion of regenerate healing always preceded docking site consolidation.
CONCLUSIONS:The application of demineralized bone matrix and autologous bone marrow is at least equivalent to autologous cancellous bone graft in terms of substantially reducing docking site healing time compared with closed compression alone. The application of demineralized bone matrix and autologous bone marrow is an effective treatment option, with minimal donor site morbidity, for reducing consolidation time of the docking site in tibial defects treated with distraction osteogenesis.
LEVEL OF EVIDENCE:Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence. |
| doi_str_mv | 10.2106/JBJS.J.00514 |
| format | Article |
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METHODS:Between 1995 and 2008, forty-three patients (mean age, 38.28 years) were managed with bone transport for the treatment of a tibial bone defect (mean length, 9.49 cm). The patients were divided into three groups according to the “docking site procedure” usedclosed compression (Group A), surgical debridement of the docking site and application of autologous iliac bone graft (Group B), or surgical debridement and local application of bone marrow concentrate and demineralized bone matrix (Group C). Docking site consolidation was assessed both radiographically and clinically, and the results were statistically analyzed.
RESULTS:The median “healing time” required for docking site consolidation was significantly longer in the compression group as compared with the demineralized bone matrix plus bone marrow group (p = 0.021), whereas there was no difference between the other groups. There was no significant difference among the groups in terms of complication rates (p = 0.702). Docking site consolidation was completed prior to regenerate consolidation in nine of the ten patients in Group C and in 13.6% of the patients in Group B, whereas in all of the remaining patients, completion of regenerate healing always preceded docking site consolidation.
CONCLUSIONS:The application of demineralized bone matrix and autologous bone marrow is at least equivalent to autologous cancellous bone graft in terms of substantially reducing docking site healing time compared with closed compression alone. The application of demineralized bone matrix and autologous bone marrow is an effective treatment option, with minimal donor site morbidity, for reducing consolidation time of the docking site in tibial defects treated with distraction osteogenesis.
LEVEL OF EVIDENCE:Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.</description><identifier>ISSN: 0021-9355</identifier><identifier>EISSN: 1535-1386</identifier><identifier>DOI: 10.2106/JBJS.J.00514</identifier><identifier>PMID: 21471421</identifier><language>eng</language><publisher>United States: Copyright by The Journal of Bone and Joint Surgery, Incorporated</publisher><subject>Adolescent ; Adult ; Aged ; Bone Marrow Transplantation - methods ; Bone Matrix - transplantation ; Bone Remodeling - physiology ; Bone Transplantation - methods ; Cohort Studies ; Combined Modality Therapy ; Debridement - methods ; Female ; Follow-Up Studies ; Fractures, Ununited - diagnostic imaging ; Fractures, Ununited - surgery ; Graft Rejection ; Graft Survival ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Osteogenesis, Distraction - adverse effects ; Osteogenesis, Distraction - instrumentation ; Osteogenesis, Distraction - methods ; Radiography ; Retrospective Studies ; Risk Assessment ; Statistics, Nonparametric ; Tibial Fractures - diagnostic imaging ; Tibial Fractures - surgery ; Treatment Outcome ; Young Adult</subject><ispartof>Journal of bone and joint surgery. American volume, 2011-04, Vol.93 (7), p.671-678</ispartof><rights>Copyright 2011 by The Journal of Bone and Joint Surgery, Incorporated</rights><rights>2011 by the Journal of Bone and Joint Surgery, Incorporated</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3679-40eb0af99e95f96d10a1eb72e2c65e577e5642756ad2df5056c9d8df4af694753</citedby><cites>FETCH-LOGICAL-c3679-40eb0af99e95f96d10a1eb72e2c65e577e5642756ad2df5056c9d8df4af694753</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,27907,27908</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21471421$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hatzokos, Ippokratis</creatorcontrib><creatorcontrib>Stavridis, Stavros I</creatorcontrib><creatorcontrib>Iosifidou, Eirini</creatorcontrib><creatorcontrib>Karataglis, Dimitrios</creatorcontrib><creatorcontrib>Christodoulou, Anastasios</creatorcontrib><title>Autologous Bone Marrow Grafting Combined with Demineralized Bone Matrix Improves Consolidation of Docking Site After Distraction Osteogenesis</title><title>Journal of bone and joint surgery. American volume</title><addtitle>J Bone Joint Surg Am</addtitle><description>BACKGROUND:Distraction osteogenesis is used for the reconstruction of extensive osseous defects. Delay in docking site consolidation results in significant prolongation of this surgical procedure. The primary aim of the present study was to retrospectively compare three different treatment options, all aimed at improving and accelerating docking site consolidation. We further sought to clarify whether the application of autologous bone marrow cells combined with demineralized bone matrix would substantially improve docking site consolidation.
METHODS:Between 1995 and 2008, forty-three patients (mean age, 38.28 years) were managed with bone transport for the treatment of a tibial bone defect (mean length, 9.49 cm). The patients were divided into three groups according to the “docking site procedure” usedclosed compression (Group A), surgical debridement of the docking site and application of autologous iliac bone graft (Group B), or surgical debridement and local application of bone marrow concentrate and demineralized bone matrix (Group C). Docking site consolidation was assessed both radiographically and clinically, and the results were statistically analyzed.
RESULTS:The median “healing time” required for docking site consolidation was significantly longer in the compression group as compared with the demineralized bone matrix plus bone marrow group (p = 0.021), whereas there was no difference between the other groups. There was no significant difference among the groups in terms of complication rates (p = 0.702). Docking site consolidation was completed prior to regenerate consolidation in nine of the ten patients in Group C and in 13.6% of the patients in Group B, whereas in all of the remaining patients, completion of regenerate healing always preceded docking site consolidation.
CONCLUSIONS:The application of demineralized bone matrix and autologous bone marrow is at least equivalent to autologous cancellous bone graft in terms of substantially reducing docking site healing time compared with closed compression alone. The application of demineralized bone matrix and autologous bone marrow is an effective treatment option, with minimal donor site morbidity, for reducing consolidation time of the docking site in tibial defects treated with distraction osteogenesis.
LEVEL OF EVIDENCE:Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Bone Marrow Transplantation - methods</subject><subject>Bone Matrix - transplantation</subject><subject>Bone Remodeling - physiology</subject><subject>Bone Transplantation - methods</subject><subject>Cohort Studies</subject><subject>Combined Modality Therapy</subject><subject>Debridement - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Fractures, Ununited - diagnostic imaging</subject><subject>Fractures, Ununited - surgery</subject><subject>Graft Rejection</subject><subject>Graft Survival</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Osteogenesis, Distraction - adverse effects</subject><subject>Osteogenesis, Distraction - instrumentation</subject><subject>Osteogenesis, Distraction - methods</subject><subject>Radiography</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Statistics, Nonparametric</subject><subject>Tibial Fractures - diagnostic imaging</subject><subject>Tibial Fractures - surgery</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0021-9355</issn><issn>1535-1386</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkcFy0zAQhjUMDA2FG2dGNy51WMmSHB3TBEozZXoonD2KvUpEbatIMgHegXdGbgJXTprd-fYfzf8R8prBnDNQ7zaXm7v5Zg4gmXhCZkyWsmDlQj0lMwDOCl1KeUZexPgVAISA6jk540xUTHA2I7-XY_Kd3_kx0ks_IP1kQvAHehWMTW7Y0ZXvt27Alh5c2tM19nkIpnO_8up0kIL7Qa_7h-C_Y8wHQ_Sda01yfqDe0rVv7qekO5eQLm3CQNcupmCaR-I2JvQ7HDC6-JI8s6aL-Or0npMvH95_Xn0sbm6vrlfLm6IpVaULAbgFY7VGLa1WLQPDcFtx5I2SKKsKpRK8ksq0vLUSpGp0u2itMFZpUcnynLw95uY_fxsxprp3scGuMwPmJmqdi1K6rOC_5EIxDoKLibw4kk3wMQa09UNwvQk_awb1ZKqeTNWb-tFUxt-cgsdtj-0_-K-aDIgjcPBd7ized-MBQ71H06V9DskyFS8LDoyBAAXFtNLlH2JLn-0</recordid><startdate>20110406</startdate><enddate>20110406</enddate><creator>Hatzokos, Ippokratis</creator><creator>Stavridis, Stavros I</creator><creator>Iosifidou, Eirini</creator><creator>Karataglis, Dimitrios</creator><creator>Christodoulou, Anastasios</creator><general>Copyright by The Journal of Bone and Joint Surgery, Incorporated</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7QP</scope></search><sort><creationdate>20110406</creationdate><title>Autologous Bone Marrow Grafting Combined with Demineralized Bone Matrix Improves Consolidation of Docking Site After Distraction Osteogenesis</title><author>Hatzokos, Ippokratis ; Stavridis, Stavros I ; Iosifidou, Eirini ; Karataglis, Dimitrios ; Christodoulou, Anastasios</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3679-40eb0af99e95f96d10a1eb72e2c65e577e5642756ad2df5056c9d8df4af694753</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Bone Marrow Transplantation - methods</topic><topic>Bone Matrix - transplantation</topic><topic>Bone Remodeling - physiology</topic><topic>Bone Transplantation - methods</topic><topic>Cohort Studies</topic><topic>Combined Modality Therapy</topic><topic>Debridement - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Fractures, Ununited - diagnostic imaging</topic><topic>Fractures, Ununited - surgery</topic><topic>Graft Rejection</topic><topic>Graft Survival</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Osteogenesis, Distraction - adverse effects</topic><topic>Osteogenesis, Distraction - instrumentation</topic><topic>Osteogenesis, Distraction - methods</topic><topic>Radiography</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Statistics, Nonparametric</topic><topic>Tibial Fractures - diagnostic imaging</topic><topic>Tibial Fractures - surgery</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hatzokos, Ippokratis</creatorcontrib><creatorcontrib>Stavridis, Stavros I</creatorcontrib><creatorcontrib>Iosifidou, Eirini</creatorcontrib><creatorcontrib>Karataglis, Dimitrios</creatorcontrib><creatorcontrib>Christodoulou, Anastasios</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Calcium & Calcified Tissue Abstracts</collection><jtitle>Journal of bone and joint surgery. American volume</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hatzokos, Ippokratis</au><au>Stavridis, Stavros I</au><au>Iosifidou, Eirini</au><au>Karataglis, Dimitrios</au><au>Christodoulou, Anastasios</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Autologous Bone Marrow Grafting Combined with Demineralized Bone Matrix Improves Consolidation of Docking Site After Distraction Osteogenesis</atitle><jtitle>Journal of bone and joint surgery. American volume</jtitle><addtitle>J Bone Joint Surg Am</addtitle><date>2011-04-06</date><risdate>2011</risdate><volume>93</volume><issue>7</issue><spage>671</spage><epage>678</epage><pages>671-678</pages><issn>0021-9355</issn><eissn>1535-1386</eissn><abstract>BACKGROUND:Distraction osteogenesis is used for the reconstruction of extensive osseous defects. Delay in docking site consolidation results in significant prolongation of this surgical procedure. The primary aim of the present study was to retrospectively compare three different treatment options, all aimed at improving and accelerating docking site consolidation. We further sought to clarify whether the application of autologous bone marrow cells combined with demineralized bone matrix would substantially improve docking site consolidation.
METHODS:Between 1995 and 2008, forty-three patients (mean age, 38.28 years) were managed with bone transport for the treatment of a tibial bone defect (mean length, 9.49 cm). The patients were divided into three groups according to the “docking site procedure” usedclosed compression (Group A), surgical debridement of the docking site and application of autologous iliac bone graft (Group B), or surgical debridement and local application of bone marrow concentrate and demineralized bone matrix (Group C). Docking site consolidation was assessed both radiographically and clinically, and the results were statistically analyzed.
RESULTS:The median “healing time” required for docking site consolidation was significantly longer in the compression group as compared with the demineralized bone matrix plus bone marrow group (p = 0.021), whereas there was no difference between the other groups. There was no significant difference among the groups in terms of complication rates (p = 0.702). Docking site consolidation was completed prior to regenerate consolidation in nine of the ten patients in Group C and in 13.6% of the patients in Group B, whereas in all of the remaining patients, completion of regenerate healing always preceded docking site consolidation.
CONCLUSIONS:The application of demineralized bone matrix and autologous bone marrow is at least equivalent to autologous cancellous bone graft in terms of substantially reducing docking site healing time compared with closed compression alone. The application of demineralized bone matrix and autologous bone marrow is an effective treatment option, with minimal donor site morbidity, for reducing consolidation time of the docking site in tibial defects treated with distraction osteogenesis.
LEVEL OF EVIDENCE:Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.</abstract><cop>United States</cop><pub>Copyright by The Journal of Bone and Joint Surgery, Incorporated</pub><pmid>21471421</pmid><doi>10.2106/JBJS.J.00514</doi><tpages>8</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Bone Marrow Transplantation - methods Bone Matrix - transplantation Bone Remodeling - physiology Bone Transplantation - methods Cohort Studies Combined Modality Therapy Debridement - methods Female Follow-Up Studies Fractures, Ununited - diagnostic imaging Fractures, Ununited - surgery Graft Rejection Graft Survival Humans Kaplan-Meier Estimate Male Middle Aged Osteogenesis, Distraction - adverse effects Osteogenesis, Distraction - instrumentation Osteogenesis, Distraction - methods Radiography Retrospective Studies Risk Assessment Statistics, Nonparametric Tibial Fractures - diagnostic imaging Tibial Fractures - surgery Treatment Outcome Young Adult |
| title | Autologous Bone Marrow Grafting Combined with Demineralized Bone Matrix Improves Consolidation of Docking Site After Distraction Osteogenesis |
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